Active ILM peeling in IEMM surgery may be responsible for visual impairment related to its microtraumatic effects.

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Purpose The efficacy of MabThera to treat Graves'orbitopathy (GO) is actually controversial, because of opposite results of the 2 randomized controlled trials (Stan M et al. J Clin Endocrinol Metab 2015; Salvi M et al. J Clin Endocrinol Metab 2015). Methods Real‐life use and efficacy of Mathera in GO in a multicentre retrospective study. Patients were enrolled in case of cortico‐dependant/resistant GO, with the help of endocrinologists of the French Thyroid Research Group. GO were classified according 3 components: inflammatory (CAS ≥3), muscular (constant diplopia) and neurological (visual acuity<20/40). Success was defined by the improvement of one component of the orbitopathy, without any deterioration of others. Results 40 patients were included. 5 of the 8 patients treated simultaneously by mabthera and orbital decompression (visual threatening disease) had favourable evolution. 32 were treated because of corticoresistant disease (mean cumulative corticoid dose of 8 g; mean disease duration of 19,1 months). 6 months success was achieved for 67,5% of this group. Initial CAS (3,28 ±1,57) was significantly reduced after 3 and 6 months (1,61 ±1,1; p< 0,01). Initial visual acuity improved significantly after 3 months. All diplopic patients remained diplopic. Logistic regression revealed that initial CAS ≥3 were associated with positive treatment response (OR 3.43); smoking status was a negative pronostic factor (OR 10). Conclusions We present the largest cohort of patients treated by Mabthera for GO. Our mean decrease of CAS after 6 months (1.68) is better than Stan's study (1.2), but not as good as Salvi (3.8). This could be explained by our delay before treatment initiation, quicker than Stan (28.9 months) but longer than Salvi (4.5 months). Mabthera could be useful second line treatments in case of recent and still active GO.

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